Garry Rayno's State House Dome: Medicaid panel set to be heard

The Commission to Study the Expansion of Medicaid Eligibility will complete its work Tuesday, when it votes on a final report recommending the state use private insurance when possible to cover poor adults instead of the state-federal health insurance program, which would be a last resort.

The commission's final decision about expansion has never been in doubt because Democrats appointed five of the nine members.

What has been in doubt - and continues to be - is whether the proposed expansion includes enough incentives for two or more Senate Republicans to jump ship and join their Democratic counterparts to approve a plan that would add about 49,000 people to the Medicaid rolls and pay state health care providers $2.4 billion in federal money over the next seven years.

Republicans hold a 13-11 advantage in the Senate and held together on Medicaid expansion the first time around to block it. At the time, Sen. Nancy Stiles, R-Hampton, pressed then-Senate President Peter Bragdon, R-Milford, saying there needed to be the opportunity for talks to continue and not let the issue die until next year.

Bragdon suggested lawmakers study expansion for a year, but during budget negotiations, the study period was shortened to three months. Bragdon named Stiles to the commission, and she voted with the 6-2-1 majority for the recommended plan.

Even if she supports the recommendation when it comes before the Senate, one more Republican would probably still need to be convinced that expansion is in the state's best interest.

It is good to remember the commission's recommendation is a starting point. As the Legislature begins to work on the proposal, the real negotiations begin.

If those negotiations go well and four or five Senate Republicans or more join Democrats to approve some expansion plan, then the Legislature will be called into special session around the first of November.

If the negotiations do not go well, there would be little incentive for Gov. Maggie Hassan to call a special session just to watch expansion go down in flames.

During the next few weeks, there will be posturing, press releases, news conferences and lots of rumors.

If a special session is called, know a deal has been cut.

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Northern Pass: Public Service of New Hampshire officials spent a good part of the summer traveling around the state hosting open houses to explain the proposed Northern Pass power line project, which would carry hydro-electic power from the Canadian border to Deerfield for distribution in New England.

Proponents say it would be good for the New Hampshire economy; opponents say it would mar the countryside.

While the project has yet to receive many of the permits it would need, the battle has intensified recently.

Opponents will hold special briefings across the state this month: Oct. 18 in Bethlehem, Oct. 21 in Concord and Oct. 23 in Portsmouth.

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Gas Tax: Highway infrastructure improvements will be a major issue during the 2014 session.

In the last session, a proposal was made to increase the gas tax by 12 cents to fix the state's roads and bridges and finish Interstate 93 expansion from the Massachusetts border to Manchester. It passed the House, but went down in the Senate, 18-6.

Senate Transportation Committee Chairman Sen. Jim Rausch, R-Derry, told his fellow senators at the time they needed to do something about the deteriorating highway system or they should not run for reelection.

He said he was assured by then-President Bragdon he could bring back something in 2014.

Bragdon has been replaced by Chuck Morse, however, and the Salem Republican has adamantly opposed increasing the gas tax.

Discussions are ongoing, but it looks like a 5 cent gas tax increase will be proposed and tied to the rate of inflation in an attempt to end the state's current situation: having a tax that has not been raised since 1991, limiting the work that can be don on the state's roads and bridges.

The proposal will probably pass the House, but it's unknown whether Morse will let it reach the Senate floor.